Abstract

To the editor: Intrathecal amphotericin B therapy is required to treat coccidioidal meningits because intravenous amphotericin administration does not produce therapeutic concentrations in the cerebrospinal fluid. Most authorities recommend that the intrathecal treatment be continued until coccidioidal complement-fixing antibodies are no longer detectable in the cerebrospinal fluid (1, 2). Prolonged amphotericin therapy, however, has resulted in both transient and permanent drug-related neurologic deficits (3). Concurrent use of intrathecal corticosteroids ameliorates amphotericin-induced inflammation, but guideline for such combined treatment are vague. Our patient received amphotericin B intrathecally for 6 years because complement-fixing antibodies in the cerbrospinal fluid persisted in low titer.